High-Flow Nasal Therapy Treatment’s Favorable Outcome in Severe Respiratory Acidosis Associated with Acute Right Ventricular Failure

Abstract

Context : Non-invasive ventilation (NIV) is now the first-line treatment of acute respiratory acidosis (RA). When acute right ventricular failure (ARVF) is associated to respiratory acidosis, hemodynamic variations due to positive pressure ventilation may worsen right cardiac output. High-flow nasal cannula (HFNC) is currently recommended to treat acute hypoxemic respiratory failure, but some studies reported that hypercapnic respiratory failure might be treated by HFNC.

Case presentation : We have reported the case of a 67-year-old woman with a history of chronic respiratory failure, who had suddenly developed an acute respiratory failure with hypercapnic acidosis due to bilateral pulmonary embolism. Because of associated ARVF, we did consider HFNC as a lower-risk treatment than NIV by reducing potential life-threatening cardiopulmonary interactions of positive pressure. We did expect improvement on both hypoxia and hypercapnia.

Conclusions : HFNC has provided a favorable outcome on respiratory acidosis in an unsafe indication of NIV due to compromised hemodynamic state.